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On April 2, Stephanie Covington ran a workshop in London on trauma-informed practice for staff working in women's prisons.

The workshops addressed the negative impact that trauma has on women's mental and physical health, how this can result in coming into contact with the criminal justice system (and other adverse outcomes), and how custody staff should adjust their practice to be trauma-informed.

The workshop was attended by a range of practitioners, from prison officers to health care workers, all keen to learn about and implement gender-responsive services within their area of work. This included from every women's prison in England.

Here are just some of the comments the participants made

'Highlighting the brutal treatment of women offenders saddened me but the positivity of the training inspired me to fight harder to make a difference.' – Magda Nichols, Bedfordshire Probation Trust

'Superb. Inspirational. Helped me to re-connect to why I joined the probation service and the professional Violence Against Women and Girls strategy.' – Mary Doyle, HMP New Hall and West Yorkshire Probation

'The training helped me consider how much my service addresses the histories of the women who we work with.' – Heather Wyant, Cameo Service: HMP Foston Hall

'The training was excellent, and as a serving Prison officer it reinforces everything I try to achieve with the women I work with.' – Emma Guthrie, PIPE: HMP Low Newton

'[The training] makes a daunting subject to work with more simplified and realistic. So fortunate to have attended – wish all staff working with female offenders had the opportunity to get such knowledge.' – Emma Burgin, HMP Foston Hall

The problem with organising an ambitious and inspiring set of events for over 600 people over 2 weeks is what on earth to do next!

Dr Stephanie Covington visited Stirling, Gloucester, Cambridge and London. Individuals were involved from the front line prison officer to our Under Secretary for Justice, Simon Hughes MP, who hosted an evening with Stephanie in the House of Lords.

The feedback we had was encouraging to say the least. It seems that people want to get Trauma Informed and to learn how and why this differs from men to women.

Anyone can do it

It's not about becoming a psychiatrist, it's not about psychoanalysis, it's about being aware of others troubles and how one may act in a sensitive way in order to prevent situations escalating into dangerous ones.

It's about helping to protect the vulnerable women in one's care but at the same time looking after one's own health and happiness at work.

For a woman who may be using a service for the first time it's not only about the smile at reception, the 'how are you today?', 'you look upset, what's wrong? Shall we talk?' but also the physical environment in which that women finds herself.

Is this place of 'help', this place of 'safety' somewhere you would go? Somewhere you would like to be? Is it somewhere you would send or leave your child? If not why should anyone else be expected to go?

Trauma informed practice

Any of us in any profession can benefit from the trauma informed teachings of Dr Covington. She uses the great example of her dentist who realised that she needed to become trauma informed and make her patients feel more at ease on their visits.

Following a training session for staff changes were made immediately. Patients were told that they were free to get up off the chair and to move around whenever they felt like it, they shouldn't feel trapped. A TV was screwed to the ceiling so the patient could watch from the chair whilst being reclined. They were warned before intrusive work into the mouth or if the dentist had to lean over their body. Many of these things are prime triggers for female trauma survivors.

These practices are embedded in evidence based theory. All over the US, states have incorporated this work and have achieved some simply staggering results. We ignore this at our own peril.

Affirming and simple

The teachings were affirming, human, simple, non expensive. They were things that we can and should incorporate into our criminal justice practice and of course beyond in the case of the dentist example.

It is time that practitioners, staff and anyone involved in working with vulnerable women or girls demand the change we need. Lone voices are no good. This change needs to be pushed in each and everyone's organisation and the trauma informed drum needs to be beaten very hard and very loud.

Please help us to make Dr Covington's visit more than a talking shop and be the change you want to see.

Eva Roussou from Together shares her reflections on the two day training session Stephanie Covington recently ran in Cambridge

The two days have been absolutely brilliant and thought provoking. Stephanie was very approachable and friendly and caring, and at the same time absolutely to the point and professional. I found everything in her training meaningful, relevant and understanding of the restrictions that budgets can create, focused on what works and not, what looks good in publications or is attractive to research. Or ticking the evidence base box - she actually said we want VALUES-based services using evidence based material.

Packages that are low cost and can make a difference

She has my absolute respect for creating intervention packages, that have low cost, and that one member of staff can train in and take back to the organisation and share. Also, she put trauma and healing work in an international context, and I think this is something that needs to be heard more in the UK, as things can be a bit introverted here. The approach and cost of Stephanie's interventions for me means that charities, like ours, around the world can use the material and make a difference and this is massively important. For a very reasonable fee we can buy the tools and deliver them as part of our women's interventions.

The importance of senior staff buy-in

An important point: Stephanie mentioned that for organisations to go away from the seminars and make changes to work in a-trauma informed way, she needed senior management to attend, not just practitioners, as changes cannot happen if the people at the top do not understand this perspective. I agreed with this, given that day one had a lot of elements that as manager I went away thinking is this a change we can realistically create, is that something that we can adapt as a service etc. Day two was going through the material, and a presentation from ISIS regarding how they transformed their services. Most organisations had managers there, and some came with their directors too - however perhaps not enough practitioners.

Being systematic

Working in a trauma-informed way is much broader and will require bigger discussions and decisions. Part of Stephanie's approach is actually systemic.

One of the best trainings I've had and massively useful from both practitioner and manager perspective (and especially the latter) - absolutely worth bringing her over.

'When I entered the court cell, the young woman, Jess, was sat in the corner staring at the floor. She didn't lift her head. I explained who I was and without any response, she followed me to the interview room, passed the male security staff, her male solicitor, the male drugs worker hurrying down the corridor – and there, in brief responses to my enquiries, Jess painted a picture of a childhood without love and care and a young adulthood of hopelessness - drugs, crime, prison, sleeping on sofas, pills for depression and a partner who did 'love' her but hit her. Repeatedly.'

This story recounted by one of our women practitioners was unique to Jess and our subsequent support was a response to her individual needs. But it is a story all too familiar to the hundreds of women that Together's Criminal Justice services come across every year who have experience of trauma. Women who are stuck in a revolving cycle within the UK's criminal justice, health and social care settings: our prisons, probation offices, homelessness services, refuges, hostels and so on. Women who are vulnerable to further violence and abuse by others. Women who have lost their homes. Women who have had their children taken from them. Women who are hurting and killing themselves through self-harm and suicide.

Recognising the effects of abuse and trauma

As a Forensic Psychologist talking about Jess to colleagues, I may well have referred to her as having a 'history of abuse and trauma'. I'm sure that Jess however, would not have used the word 'trauma' to describe her experiences. I'm also sure that many of the professionals and services Jess had so far encountered in her young life, would not have had the knowledge to identify her experiences or to understand their impact on her behaviour or so-called 'lifestyle' choices.

As professionals working in criminal justice, health and social care services, how can we recognise, acknowledge and support women who have experienced trauma, such as violence and abuse?

Developing trauma-informed practice

A woman may often be reluctant or not ready to disclose, particularly to a professional she has just met, and in a context as stressful as a police station or remand cell. Her traumatic experiences may well be masked (whether intentionally or not) by aggressive or withdrawn behaviours. And even if they aren't, information needs to be elicited in a way that doesn't result in her reliving painful experiences, disclosing too much in an environment that isn't safe for her, or any number of other destructive scenarios.

How do we then ensure that our responses take into account that woman's individual experiences and needs at the point of contact with frontline services?

People often don't present in predictable, easily described ways and there is a fine balance to be struck. Effectively working with women at risk is much more than just acknowledging the existence of a traumatic experience, but it also stops short of tackling trauma head-on when this isn't appropriate. A woman has to be ready and willing to engage with interventions to help her manage and address past, distressing experiences, and this needs to happen in a safe environment and facilitated by a qualified professional. In a criminal justice setting, a crucial first priority is often to deal with urgent practical issues to ensure the woman is safe and in stable circumstances. Working with her to then understand what actions and agencies may improve her situation and wellbeing may be a long process, and one that she should be supported to lead.

Mindful and compassionate approaches

This trauma informed approach underpins the pioneering work of US clinician and trauma expert Dr Stephanie Covington to advocate for, develop and implement gender-responsive environments in both custody and the community.

The programme of events being delivered by Stephanie Covington across the UK over the next month, and convened by our Women at Risk coalition, is timely. We want to take advantage of the opportunities presented by the systemic changes currently being made within our justice, health and social care structures and advocate for this approach to be embedded in existing services and as part of reforms. We are not describing revolutionary new ways of working that require huge investment and training in specialist techniques or therapeutic interventions. We are advocating for the adoption of mindful and compassionate approaches – ones that help us to: see beyond the crime, the anger, the drug-use, the missed appointments, understand that slamming the cell door may provoke shock and re-lived painful experiences, design our services so that women actually choose to use them and feel safe to do so; approaches that in our experience are vital to reducing distress and can have a profound impact on the lives of women at risk.

Why would an organisation that focuses solely on behalf of families affected by imprisonment want to host a workshop on trauma-informed practice for work with women in the criminal justice system? It may not be an obvious link, but for Families Outside this work is crucial.

Dr Stephanie Covington's series of workshops in the UK starts in Scotland on Monday and Tuesday the 24th and 25th March. As part of the Women at Risk coalition that has organised and sponsored these events, Families Outside is committed to promoting a trauma-informed approach for a number of reasons.

The trauma of separation

First, two-thirds of women in prison in the UK are mothers of dependent children, and the separation of families through imprisonment can be tremendously damaging. Trauma is often a key factor behind women's offending, such as for women who self-medicate to mask experiences of abuse. In recognising and addressing trauma, we are addressing the reasons behind women's offending and consequently reducing future risk.

Applying a trauma-informed perspective

Second, the message of trauma-informed practice is transferable. While the workshop is aimed at practitioners working with women in the criminal justice system, the lessons apply readily to men who have experienced trauma or, in our case, to children and families. Children who have witnessed a parent's arrest, for example, can be highly traumatised by the experience, especially where the arrest was sudden, unexpected, or violent. The experience of visiting prison for these children can force them to re-live this experience, putting them in a noisy and unfamiliar environment surrounded by people who, to them, look like police and who take their family member away from them time and again.

Families Outside is pleased to be part of the Women at Risk coalition and to co-host Dr Stephanie Covington's workshops in Scotland alongside the Scottish Prison Service. Participants should be able to roll out the learning to their colleagues and ensure that front-line practitioners in Scotland are able to use trauma-informed approaches to recognise and support people who have been through such experiences.

Trauma-informed practice is not just important for experts or therapists or people working with women in prison: it's for all of us.

There are c.3,850 women in prison in England and Wales today and a further c.19, 000 under probation supervision. As a clinician working in a woman's prison over the last eight years, it is clear to me that many of these women have had unwanted sexual experiences and witnessed and suffered physical violence in childhood. This is often exacerbated by additional trauma and violence in adult life. Clinical teams, probation and prison staff often recognise this. The challenge, for all of us, is knowing both what to do to help the individual woman and how to build services that offer an appropriate institutional response.

Building on existing awareness

We need to capitalise on the existing awareness in prisons that gender sensitive care is important. This approach must be embedded in the way everyone works. That means it is more likely we will avoid reinforcing the kinds of negative experiences women may have had previously. Physical restraint is a distressing but sometimes inevitable component of both prison life and secure hospital care. It must be used carefully. Everyone involved must be mindful of how easy it is for this to resonate with sexual and physical violence from the past. Gender sensitive care means thinking about the ratios and roles of male and female staff; it means remembering that being victimised, with all that so often goes with it, can make it hard to speak up for yourself in a way that works.

Understanding self-destructive behaviour

At an individual level, we have to be good at decoding what is often literally not written, but cut into or inserted into the bodies of women when they self-harm. We need to understand and actively think about why women use drugs and alcohol in self-destructive ways. But part of helping women break free of unhelpful, coping methods is to allow them to decide when is the time and what is the place to work on their past – and to give them a range of options.

It's up to us

Stephanie Covington's visit and the knowledge and experience she can share are timely. She has done much to raise awareness in North America of how trauma affects women's lives and has helped build the vocabulary that allows everyone to think together, out loud. But it is ultimately up to us in the UK to share the work that is already happening, use what has been effective in Canada and the US and then create sustainable initiatives. That is why part of Stephanie's visit will include not only hearing about good practice around the UK but using that as a springboard to a tailored, UK wide, set of interventions.These need to be tested out to see if they appeal to the women, to see if they work and what they cost.

Moving on from past traumas

It is crucial that women at risk or in contact with the CJS, get opportunities to reshape their lives and move on from the traumatic events that have so often damaged their life chances to date. There is a real opportunity right now. I think there is a willingness amongst at least some commissioners of services to support this area of work, which may, as a by-product also reduce re-offending.

Imagine half a dozen people in a room, apparently just having a coffee and talking. They meet perhaps once a week. One of them – and you may not immediately be able to spot which - is a convicted sex offender, recently released from prison. They aren't quite friends, but they have all volunteered to be there and to spend quite a lot of time together over a period of months or even years.

Back in 2003, when I wrote the article in Criminal Justice Matters, this kind of meeting was very rare in Britain, as Quakers and others were still piloting Circles of Support and Accountability. Now there are 14 projects, covering a high proportion of England and Wales, and more are in the development phase. Circles UK supports all of these and ensures high standards are maintained. In 2012/2013, ten years on from my article, 80 individual Circles were provided – and the number continues to grow. The latest news is that the Cabinet Office, through a Rehabilitation Social Action Fund award, is funding a further 74 Circles. And Circles UK is also advising initiatives in the Netherlands, Belgium, Latvia, Bulgaria and Catalonia.

So Circles of Support and Accountability are now available to a much higher proportion of the people who need them than before. Letters still arrive at the office of Circles UK from prisoners who desperately want to have a Circle when they are released. Men (and occasionally women) who are fearful of release, who know they will need a lot of help if they are to avoid slipping back towards offending behaviour. But now those letters have a better chance of a positive answer.

As the concept has spread, some of our tentative conclusions have been proved right. There are enough people with the motivation and the qualities it takes to commit themselves to be Circles volunteers – though some effort still has to be put into finding them. Enough Circles have now run over a long enough period to generate reliable UK-based statistics. These demonstrate clearly that the approach really is remarkably effective. Across the 250 or so Circles which have been provided in the past eleven years there is evidence of just ten reconvictions for sexual offences; a much smaller number than statistically would be expected for this group of medium or high risk offenders. There's plenty more information on the Circles UK website.

In the early days, probation, police and prison staff were understandably nervous about a project which worked with high-risk sex offenders and relied on volunteers. But acceptance of the concept has spread as people have seen the results. Circles projects and Circles UK itself have won awards and plaudits. Lord Ian Blair, former Commissioner of the Metropolitan Police, said 'This isn't an easy ride for the released sex offender, but at least it gives them some hope; and for people (Circle Volunteers) to do that in their spare time is a remarkable thing to do. And I salute them.'

Every Circle has as its key aim 'No more victims' – it is an expression of community commitment to community safety, and a vivid example of what 'ordinary' people can do to with a bit of high-quality support.

Helen Drewery is General Secretary of Quaker Peace and Social Witness, which works with Quakers across Britain to help them to live out their faith in their lives. Helen has worked for the Quakers for nearly 30 years, addressing a wide variety of social justice issues. From 1999 to 2009 she played a key part in bringing Circles of Support and Accountability to this country, including serving as a Trustee of Circles UK.

In this short video Dr Stephanie Covington talks about what motivated her to work with women in custody.

Speaking of one of her first encounters with women in custody she remarks:

'As I stood there with them I had this thought which was "Why are you in there and I'm out here?". And the next thing that came into my mind was "Privilege".'

Stephanie says that she thinks there are two things that women participating in any of her programmes can learn:

'First, that she is a valuable women. And second, that change is possible. That recovery from addiction and healing from trauma can happen for her.'

Stephanie delivered an ambitious programme of training and awareness raising among policy makers, criminal justice and health workers, ex-prisoners, trauma survivors and activists in Scotland and England in late March and early April 2014.

The world's leading expert on trauma in custody, Dr Stephanie Covington, is coming to Britain in late March to kick start a revolution in how we treat female survivors of trauma in custody and in the community.

She will be concentrating on the unique needs of women and to expand on gender responsive policies to show how they may be embedded in practice. She will highlight how the experience of trauma can have acutely adverse effects on the lives of women and girls both in the community and custodial settings and how best to manage these complex problems.

The need for action

As a member of the Women at Risk Coalition it was important to me to see some action on this issue. We can throw as many treatment programs at vulnerable woman as we like. If the people who look after such vulnerable women don't know how to care for them properly then there is little point. The hard work will be undone, damaged women will become more damaged, confrontations can escalate into violence. At such times a little training could go a long way to easing highly volatile situations.

Safer for women in custody, safer for staff

From parliament to the frontline, from Scotland to London, Stephanie Covington will work with policy makers, prison staff, police, probation, charitable organizations, health staff, ex-prisoners and survivors to highlight how trauma manifests itself differently in males and females and how important it is to grasp this issue and to embed it in future policy decisions.

The training she will provide during this time will be the start of a real shift in how people who work with vulnerable women and girls react to the challenging behaviours they face such as acute anger problems, self mutilation and suicide. This will not only help to keep staff safer but will also keep the women and girls safer who are under their care and supervision.

Better practice in prison

In a time where cuts have seen the removal of front line staff we need far more investment in training for those that remain on the front line. There is an important debate to be had about whether women should or should not be in prison, whether they get long sentences or short sentences. It is also imperative that those charged with the care of female survivors of trauma in custody are trained in how their past experiences will affect their behaviour in prison.

For all female trauma survivors it is a journey from trauma to recovery.

The Women at Risk Coalition is made up of frontline staff, senior psychiatrists, psychologists, academics and funders who between them have worked in the social care, health and criminal justice systems for many years.

They are united by a commitment to address the epidemic of mental illness among female prisoners and women at risk of criminal justice capture in Britain; an epidemic that more often than not stems from traumatic events earlier on in their lives.

From 24th March to 7th April this year, the Women at Risk Coalition will be working with the world's leading expert on trauma in custody, Dr Stephanie Covington, to deliver an ambitious programme of training and awareness raising among policy makers, criminal justice and health workers, ex-prisoners, trauma survivors and activists.

The impact of trauma

Emotional trauma can have adverse impacts on the lives of women and girls, including leading to involvement in the criminal justice system and prison secure psychiatric accommodation, chronic use of drugs and alcohol, street sex work, homelessness and other poor life trajectories.

In most systems women appear in disproportionately small numbers: five percent of the prison population; a third of the population detained in mental health settings; a third of the single homeless population in contact with services. Their needs, however, are often extreme in comparison with the majority of men in similar systems.

Women in custody are 5 times more likely to have a mental health concern than women in the general population.

78% exhibited some level of psychological disturbance when measured on reception into prison.

Women account for 31% of all incidents of self-harm despite representing only 5% of the total prison population.

1 in 3 women have suffered sexual abuse and over half have suffered domestic violence

Half have attempted suicide at some point

However 81% of women are serving a sentence for non-violent offences

The populations recorded in each of these 'systems' overlap; they are essentially the same women.

Starting a revolution

Dr Stephanie Covington, is coming to Britain to kick start a revolution in how we treat female survivors of trauma in both custody and in the community. She will be concentrating on the unique needs of women and to expand on gender responsive policies and practices for women and girls at risk.

From parliament to the frontline, from Scotland to London, she will work with policy makers, frontline staff, the police, former prisoners and survivors of trauma in order to highlight how trauma manifests itself differently in women and girls and how important it is embed a gendered response in policy decisions.

The training she will provide will be the start of a real shift in how people who work with vulnerable women and girls react to the challenging behaviours they come up against, such as anger, risk-taking and self-harm. A wider range of practioners will learn about skills and exercises that can be incorporated into work with women in a variety of settings in order to make sure that women are coming out of prison less likely put themselves in damaging situations.

Taking forward the agenda

Over the coming weeks Works for Freedom will be hosting commentary and analysis on Stephanie Covington's visit by members of the Women at Risk Coalition. They will cover a range of issues, from the why the visit is so important and what the Coalition hopes to achieve, to what they plan to do to take forward this important agenda over the longer-term and how you can get involved.